What does it mean to live in the age of Abilify?

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more for the higher dosages. There’s no generic equivalent in the U.S. as yet; Canadian and other foreign pharmacies stock the active ingredient, generic aripiprazole, for a fraction of what we pay in the states. However, Abilify’s U.S. patent protection expires next month, and aripiprazole may soon be available here at lower cost.

Abilify is an “atypical” antipsychotic. This is a confusing term, as these are now the drugs typically prescribed for schizophrenia and other psychotic conditions. The name comes from their atypical mechanism of action, as compared to the prior generation of antipsychotics. “Atypicals” also play a useful role in the treatment of bipolar disorder, where traditional medications such as lithium require blood level monitoring, and often multiple doses per day.

Antipsychotics are powerful drugs with considerable risks and side-effects. But psychosis and mania are powerful too. As with cancer chemotherapy and narcotic painkillers, a risky and/or toxic treatment can be justified in dire circumstances. It’s also true that one crisis visit to an emergency room, not to mention a psychiatric admission, may cost more than months of Abilify, and can itself be emotionally traumatic. If Abilify keeps psychosis at bay and prevents hospitalization, the risks are worth it. The cost is worth it too — if a less expensive generic atypical won’t do. Several are now available.

As I wrote in 2009, the manufacturer Otsuka tapped a much larger market for Abilify as an add-on treatment for depression. I objected to the consumer ad campaign that trumpeted this expensive, dangerous niche product for common depression. While there’s a role for Abilify in unusually severe, unresponsive depression, advertising it widely as a benign “boost” for one’s antidepressant was, and is, irresponsible. By analogy, the makers of the narcotics OxyContin and Percocet could run ads showing people with bad headaches, and urging fellow headache sufferers to ask their doctors “if Percocet is right for you.”

And these are merely the FDA-approved uses of Abilify. Atypicals are also widely prescribed off-label for use as non-addictive tranquilizers and sleeping pills, and to treat other psychiatric conditions. There’s no advertising for off-label use, so the onus falls squarely on prescribers who balance the risks and benefits of these drugs in a manner that research tends not to support. In short, a costly, risk-laden medication created to ease the awful but relatively uncommon tragedy of schizophrenia is now the top selling prescription drug in America owing to its widespread use in garden variety depression, anxiety, and insomnia.

It’s been said that the top selling drug in any era is a comment on society at that point in time. Valium held the lead during the 1960s and 70s, suggesting an age of uncertainty and anxiety. The top spot was taken over by the heartburn and ulcer medication Tagamet in 1979. Tagamet was the first “blockbuster” drug with more than $1 billion in annual sales. Cholesterol-lowering Lipitorwas the biggest seller for nearly a decade after it was released in 1997, the same year the FDA first allowed drug ads targeting consumers. Pfizer spent tens of millions on such ads — and sold over $125 billion of Lipitor over the years. The stomach medicine Nexium took over after that. Without covering all the top sellers, it’s fair to say that Americans spend a great deal on prescriptions to deal with stress and unhealthy lifestyles. The blockbusters also show how mass-marketing brand name drugs has become a highly profitable business.

What does it say about us that Abilify holds the top spot now? What does it mean to live in the age of Abilify? First, that we’re still looking for happiness and peace in a bottle of pills, costs and risks be damned. Second, that there’s nearly no end to the money the U.S. health care system will spend on problems that can be addressed more economically. And third, it’s a stark reminder that commercial interests seek to expand sales and profits whenever possible. They find (or create) new markets, promote products by showcasing benefits and concealing drawbacks, appeal to our emotions instead of our rationality. This is how business works. We should not be surprised, yet we ignore this reality at our peril, particularly when it comes to our health.

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What does it mean to live in the age of Abilify? 34 comments

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DZ-015, M.D.

I am stunned at the success of this drug given that there are so many better, cheaper and safer ways to augment antidepressant treatment.

querywoman

Oh, you don’t like me posing questions, so I’ll put my thoughts other ways.
It’s puzzling that drugs with such drastic side effects as tardive dyskinesia are being dished out like candy. I don’t believe the public asks for them. It must be the doctors dishing them out.
I don’t think Valium or opiates are all that harmful. Addicting, yes, but they shouldn’t cause repetitive muscular and nerve disorders.
Perhaps the doctors and/or the government should loosen the restrictions on addicting drugs. I don’t need them that much, so I have no interest in the issue.
I have used Desyrel in the past, and it really knocks me out. I don’t use it now and have not in years.
I take doxepin, in the lowest dose available 10 mg, because I have serious atopic eczema and chronic itching. I used to take 25 mg, but I asked my doctor to cut it.
The antihistamine effect is spectacular.
It’s generic, a $4 med, knocks me out, and I never get too used to it. I wake from a very natural sleep. I might take one or two at night two or three times a week. It stays in my system a couple of days from the last dose.
However, I just picked up a new med. It’s quite expensive but free for me on a drug program.
My new dermatologists thinks it may work on my nerves to stop fibrous growths from coming out of my skin.
It’s Thalomid, the brand name for thalidomide.
I just took my first one. I’m past the child-bearing age.
I won’t be taking doxepin with it at first till I see how sedating it is.
I have had a lifetime of abuse and neglect over my skin disease, but I have the best dermatology chain in town.

DZ-015, M.D.

300 Americans die every week from prescription drug ODs, mostly opioids. That’s two planes like the one that went down in the French Alps every week. We have 5% of the world’s population and use 80% of the world’s Vicodin. Still don’t think opioids as currently prescribed are harmful?

querywoman

So you will respond to me. It’s good to keep an open mind.
Opiates are available under other names in other countries; I’ve checked. Since Vicodin is brand name used in the US, that’s what we’ll take.
Afghanistan and Iran have the most drug addicts.
I’m not a doctor so I can’t fairly evaluate risks. I’d like to know if the opiate deaths are related to prescribed meds or dirty street drugs.
I have written before about how I know that addicts can’t get enough opiates. I cannot relate to that, because I am a very light hydrocodone user. I fill one prescription for serious skin lesion pain every 18 months.

DZ-015, M.D.

I don’t know what you want me to respond to. If you like you can get answers to all your questions with a Google search. I don’t want to derail the thread from the original topic any more because I think the article is important.

Needless to say, if someone is Abilify and it is working, they should continue. What is unexplained is how an SGA became the number one drug by use mostly in nonpsychotic people. It has to be the ads, which are filled with warnings. But they work. I think the author and I are equally puzzled by the popularity of this very expensive drug. I also don’t understand why the PBMs are greenlighting it.

querywoman

I do not care if you respond to me. You initially wondered why I responded to your stuff when you weren’t talking to me. It is a public forum.
You threw in L-methyl-folate, Desyrel, or TCA, so I threw in opiates.

I am shocked at the massive prescribing of Abilify. I saw an article once about college students who needed a mild tranquilizer or sleep med and instead got Abilify.
I will throw in a comparison. A patient newly dx’d with high blood pressure could get the latest, expensive blood pressure. Or the doctor could try many different drugs on the $4 med list.
There are also $4 antidepressants that could be used. A pharmacist told me that controlled drugs like mild tranquilizers won’t be on the $4 list. Doxepin and generic Desyrel, trazodone, are on the $4 list. I’ve used them both.
I have an open mind. I make comparisons. I have often encountered doctors who don’t have open minds. I have many open-minded docs. I describe one of my faves as, “approachable and flexible.”
Good luck to you! I have confidence that you too have an open mind.

DZ-015, M.D.

That’s because methylfolate is an alternative to Abilify for augmentation and opioids aren’t.

Let’s at least try to stay on subject here. There are other articles about the opioid problem where your comments would be germane.

querywoman

I had a reply to you, but it may be in moderation or have disappeared.
My opinion of what is “germane” and yours vary.
My comment is relevant because I assume the push to antipsychotics may have something to do with the fear of prescribing addicting tranks and opiates.
All of these “mental” drugs seem to cause a lot of confusion.
I’m not really sure what an antipsychotic is, but Abilify is a really strong drug, perhaps meant to fix “disordered” thinking? What does it really do? I don’t believe that many Americans are messed up enough to need this drug.
My mother used to have trouble sleeping. The expensive new Ambien didn’t work for her. I think I suggested she try trazodone, cheap and nonaddicting.
Trazodone seemed to work really well for her, then somebody told her it had side effects and there were newer, better drugs.
So she went on the mild Restoril, which is addicting. If she ran out, she couldn’t sleep without. Her NP had put her and my brother on Restoril. Sometimes they ran out and shared with each other, just a day or two. The NP had no problem with them sharing when Mama told her.

querywoman

Of course, I google. I googled thalidomide plenty! I just got it, two months after my doctor first suggested it!
I am an unusual case for a very expensive, very risky drug in a certain population!
It was prescribed with great care, and I think Abilify should also be prescribed with great care.

DZ-015, M.D.

Does Abilify treat the tendency to go way off topic?

querywoman

Once again, my opinion of the topic and yours differ. I do hope you don’t dismiss your own patients as “mental” when they disagree with you.
Maybe I should not have written that. Maybe it will get deleted. But it should land in your inbox!
Cheers!

Patient Kit

Opiate deaths are related to both prescribed drugs and street drugs. In addition, I’m sure to docs’ great frustration and rightfully so, a lot of opiate painkillers that docs prescribe for their patients end up being sold by those patients on the street illegally. Or stolen from those patients and sold on the street. I’d have to do some research to give you any hard stats but there is no doubt in my mind that opiate addiction is a huge problem in the US. The trick, regarding pain control, will be somehow getting the pendulum to swing back to somewhere in the middle instead of all the way back to not treating pain at all. And that will not be easy to do.

querywoman

Doesn’t alcohol still kill more? Another substance that people can’t get enough of!

querywoman

Because I ride a public bus, I assure you that I know drugs are sold. I had a conversation with some guy once about my hydrocodone once and he replied, “You sell ’em, don’t you?”
No, I don’t. I want them to be there for me when I need them. I can’t remember why, but I believe he needed them more than I do, like maybe he got 60 per month. I get 60 once over 18 months.
When my mother was in my home dying of cancer, a woman in my complex asked me if I had any hydrocodone. Of course, we had it, but I told her, “No.” I warned my mother about that.
I have a young friend who used to get about 180 hydrocodone per month. He told that he sometimes sold them. He knows better than to do that. He no longer takes opiates or tranks, but he still drinks.

morebuzzkills

“I don’t think Valium or opiates are all that harmful.” -Ummmm….we must not be on the same planet.

querywoman

Oh, good, you crawled back from the ER to respond.
Do people OD on antidepressants? Can people OD on Abilify?
Is it worse to be a slightly spacy person on a lifetime of Valium or to have TD from antipsychotics?
I took my first Thalomid last night. Of course, I researched thalidomide and learned that one of its initial pluses was that a person wouldn’t OD if they took too much.
As for opiates, I understand that some countries that legalized them have gone back to restricting them. It’s a hard question.

morebuzzkills

I am not an ER physician. And yes, people overdose on antidepressants quite frequently. People also frequently overdose on benzodiazepines and opiods.

querywoman

I know that most mild tranks need to be mixed with alcohol to be fatal, but many antidepressants are fatal enough on their own in large doses.
I bet people also commit suicide from medication-induced tardive dysk!

RenegadeRN

Good article! I have seen wonderful results with patients on Abilify, when standard meds for bipolar disorder were not really effective. However, even with those amazing results, the patients still randomly decide not to take them and end up in another crisis.
That said, marketing direct to the public has been one of the worst decisions ever made for this country’s medical spending, IMHO. Aren’t we one of only 2-3 other countries in the WORLD who allow this?

It seems the top sellers over the years have also been revealed as quite problematic to patients as far as side effects,with long term use.

Andrea

20 mg of Abilify in conjunction with 120 mg of Cymbalta kept my intractable depression stable for almost 6 years. My insurance covered it until Obamacare went into effect and the cost of the Abilify increased by 400%. I couldn’t afford it any longer and six months later I attempted suicide. When I went off the meds, it turned out that the Abilify was also keeping psychotic thoughts at bay. A year later I have found a new combination of meds that is working well and that my insurance is covering, thank God. There is no patient assistance program for Abiiify, no alternate options for coverage. I wish things could have been different, but I’m glad they worked out.

querywoman

I always believe there is a use for everything.
There is patient assistance for Abilify. Sometimes, pharmacy programs do not cover drugs if you have insurance.
I read your insurance does cover Abilify, but you cannot afford the copay since it quadrupled.
Perhaps they can make an exception for you.
Have you tried calling Bristol-Myers Squibb at 800-736-0003 to explain your situation?
However, you say that you are finally on a new combo of meds that’s working for you, so you may not want Abilify anymore. Is it cheaper?
Another option, if you have future problems is, even though you already have insurance, you might try your local public mental health services. Perhaps they would fight harder for you.

querywoman

Psychiatric dx’s are always inexact. I have had a friend for many years who always claimed to be bipolar. She did some strange behavior at age 18. I met her years later. She’s always been medication compliant.
She used to take lithium, Risperal, and maybe some antidepressant. Once she was addicted to Klonepin, but she got off it.
Then she tried Abilify, which made her feel like she was not bipolar at all. No more lithium. She even had her mother get her some in Mexico, but it wasn’t cheap there either.
I’ve not talked to her in a while. Now she says she’s been on Vyvanse for ADD a while instead and it works. No lithium or Abilify now!
I can’t make any statement on whether or not she’s really bipolar because she’s always taken her medicine. I couldn’t tolerate her if she were one of those supermanic types, and she doesn’t like being around the either.
Perhaps she has trouble calming down and focusing and the Vyvanse helps. I’ve noticed her having trouble focusing before. She rambles a little.
I think what I’m saying her is that all the so-called mental illnesses need to be well-described and carefully matched to meds, not the latest hot marketing product.

querywoman

If you make too much money for the public health sector, you can still use them and pay full price. Maybe they would argue better for you; maybe not.
I am not sure about the Abilify. I doubt things have changed. It’s just many times you talk to a person who doesn’t know what’s really going on.

Patient Kit

At $30 a pill, I’m amazed that insurance companies are willing to pay for Abilify often enough to make it one of the most commonly prescribed drugs in the US. Makes me curious about certain peoples’ stock portfolios. The ads are relentless.

querywoman

Yes, that is weird! Money is the main thing, after all!

DeceasedMD

Behind closed doors Bristol Myers squibb has done some great marketing for themselves. No doubt Big Pharma changing the DSM to focus on diagnosis that require medication. They have been quite successful with increasing methamphetamines. Just about every teenager has ADHD and now there is a new reason to prescribe….Binge eating Disorder. A completely new diagnosis now with a new addictive treatment. I give them credit. They are pretty clever and certainly good at promoting destructive drug treatments to many that have no business taking them. But then one wonders why patients agree to take it and doctors agree to prescribe it.

querywoman

Sooo expensive!!! Doctors are pushing it!
On the other hand, my doctors will gladly prescribe $4 meds for anything they can. Patient compliance goes up when meds are cheap!

SarahJ89

Ah, I like your cynical style DMD. I hadn’t thought about what fueled some of the seemingly crazy diagnostic decisions in the DSM V, but you’re making all too much sense. I wish you weren’t. (sigh)

Our move, by the way, is in mid-April. It’s all rather overwhelming at the moment as I’m married to a tax preparer and it’s tax season so I’m doing most of the heavy lifting. We have a wedding coming up. And the groom is a moving man! He’s been guiding me through the thickets of LCL shipping so I’ll be able to take my books–hooray. There’s quite a lot of detail involved with shipping our dog as we’re going to a rabies-free country that would like to stay that way (fancy that). I’m pretty excited. When I’m not glued to the ceiling.

DeceasedMD

Well many congrats to you both! Did you decide on Ireland?
Well I hope you keep in touch Sarah. 🙂 Wonderful news! Tell me more if you like. Am interested.

SarahJ89

Yep. I have citizenship so it’s a no brainer for us. You can find me at duckladynh at yahoo dot com if you care to. I’ll continue my subscription with Kevin MD also and I’m sure I’ll be weighing in from time to time once we get settled. We’ve actually swapped vehicles with a family who has a house in our US town. They’ve been living in Ireland since 2003, but have to return for a family illness (ALS, ouch). None of us are looking for extra hassles so we simply decided to swap vehicles instead of having to find something upon landing. It’s a huge relief. Our moving man/nephew-to-be is coming over today to give us some guidance on which teapots I need to leave behind. The books are mostly coming with us, though, as is the dog. Yes, we’re crazy. It helps with stuff like this.

DeceasedMD

Am impressed. You really worked it out nicely. Yes please keep in touch. It is a brave move and it sounds just wonderful like perhaps a new start for you both. Good luck to you both and we will keep in touch. I will send you an email. All the best.

querywoman

I tried repeatedly to get my teeth pulled and dentures at a low cost in Texas and got nowhere. I got all my dental work done with a life insurance check after my mother died.
Perhaps our new governor will do something!
That’s one of my my main social axes-to-grind before I die.

querywoman

They also pump this stuff en masse into old people in the nursing homes.

DeceasedMD

I am not questioning ADD or its treatment. When used appropriately it is essential. You sound competent and diligent in your practice. But the fact is, a lot of prescribers are not and I have definitely talked to more patients that admittedly do not have ADD but use them to study and it is easy to obtain. And there are definitely pts that do not get proper diagnosis and end up on these. I have seen pts with Bipolar disease that were started on amphetamines. In the NY Times it is clear that there is a trend in America to prescribe For ADHD. Drug companies have aggressively marketed these and there is definitely a negative effect on many. The drug is now used for I think 20 percent of HS teenagers. that seems high to me.